Intussusception in Incisional Hernia: A Case Report and Literature Review

Abstract

Intussusception in adults is a rare condition. Most frequently, intussusception involves the small intestine and, very rarely, the large intestine. In this report, we present the case of a 79-year-old male who was admitted with symptoms and signs of bowel obstruction due to an incarcerated incisional hernia (a tender irreducible incisional hernia associated with nausea and vomiting). His CT scan confirmed intussusception in his incisional hernia, showing the target sign. An emergency laparotomy, small bowel resection, and anastomosis were done. The histopathology report revealed the cause of intussusception to be a polypoid small bowel B cell lymphoma. It is necessary to excise the affected bowel segment in order to treat adult intussusception because it is commonly associated with malignant organic lesions. Computed tomography is the most sensitive imaging modality for intussusception; thus, we must consider a low threshold for a scan for patients presenting with abdominal pain.

Keywords: bowel obstruction; incarcerated incisional hernia; incisional hernia; intussusception; surgical management of intussusception.

Figure 1. A coronal abdominal CT scan image shows small bowel loop dilatation due to obstruction (white arrows).

Figure 2. An axial abdominal CT scan image shows intussusception in the incisional hernia and the target sign (blue arrow).

Figure 3. A high-power H&E-stained section shows large atypical lymphoid cells with irregular nuclei, coarse chromatin, and nucleoli.

Figure 4. A low-power H&E-stained section shows infiltration of tumour cells through the muscularis propria of the small bowel.